There Should be Strategies*

Last week, the White House unveiled its national strategy for fighting the opioid crisis. The proposal aims at expanding access to Medication Assisted Treatment (MAT) in the federal criminal justice system. Puzzlingly, it only includes the expansion of one form of treatment – Vivitrol – a drug manufactured by the pharmaceutical company Alkermes located in Massachusetts. The political rationale behind this decision is unclear; nobody knows why the administration only chose this drug and the efficacy of the drug itself also remains murky. But it is strange because all experts in the field of opioid addiction and all empirical evidence on the subject indicate that the most efficient way to reduce addiction in and outside of prisons is to broaden access to all forms of treatment because individuals react to specific medications in different ways. 

Another area of concern regarding the administrations decision is that Alkermes has a history of undertaking extreme marketing schemes for their products to influence prison officials, judges and lawmakers to promote their product. In November, Senator Kamala Harris (D) from California who is a member of the Senate Homeland Security and Governmental Affairs Committee opened an investigation into the companies attempts to artificially increase its own sales by undermining the credibility and availability of other products. A passage on her website reads, "For the last several years, Alkermes aggressively marketed its drug to people in the criminal justice system, often convincing judges and corrections officials to offer Vivitrol to inmates and parolees rather than treatment drugs with more proven efficacy." 

Of the 185,000 inmates in the federal prison system, one half of them are estimated to suffer from substance abuse. The White House's intention is to provide one month of Vivitrol to patients before transitioning into long term treatment options. While there is disagreement over which MATS are most effective, and how they should be prescribed, the general consensus is that providing more treatment options is the most efficient way to reach as many individuals as possible. The three other most commonly cited treatments are Methadone and Buprenorphine which are opioid based, and Naltrexone which is not. Leo Beletsky, a professor of law and public health at Northeastern stated in an article for STATNEWS, that "Methadone and buprenorphine have been shown on a variety of metrics to be far superior to Vivitrol — that includes safety, effectiveness, and cost,” and that “The reason Vivitrol is preferred is that it’s a medical version of forced abstinence. That is why it’s been the darling of those who rhetorically support medication assisted treatment.” The phrase "forced abstinence" is in reference to the drugs ability to prevent individuals from experiencing the effects of opioids and reducing cravings for them. 

There is evidence of Vivitrol's potential to decrease addiction. In November, a study published by the National Institute on Drug Abuse found Vivitrol to be as effective as buprenorphine for patients who received treatment for an extended period. However, it is less successful for individuals in need of immediate treatment because you have to be clean for ten days before taking the drug. All of this is to say that the best policy to combat the opioid epidemic is to provide as much treatment as possible to ensure that everyone who is affected has access to the treatment that works best for them. Rhode Island's Department of Correction has become the gold standard for opioid treatment in prisons by adopting a policy like this. All inmates are checked for opioid addiction and are provided therapy and medication assisted treatment that continues after their release. Since 2016, when the program was implemented, Rhode Island has experienced a 61% decrease in opioid deaths in the prison population and a 12% overall decrease. 

Side Note: 
I've attached a link to an article by Andrew Sullivan on the opioid epidemic that was recently published in New York Magazine. If you've find this blog interesting I highly recommend reading it. It explores the history of opioid use, and how the sensation produced by opioids has filled the gaping hole in society left by the erosion of its most intimate structures. Here is a quote:

"It may be best to think of this wave therefore not as a function of miserable people turning to drugs en masse but of people who didn’t realize how miserable they were until they found out what life without misery could be. To return to their previous lives became unthinkable. For so many, it still is."